Provider Demographics
NPI:1396481339
Name:CLOSE, EMILY JENNIFER (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:JENNIFER
Last Name:CLOSE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 MAIN ST, UNIT C
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450
Mailing Address - Country:US
Mailing Address - Phone:978-449-9772
Mailing Address - Fax:
Practice Address - Street 1:491 MAIN ST, UNIT C
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450
Practice Address - Country:US
Practice Address - Phone:978-449-9772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261032251X0800X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic